Southern medical journal
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Southern medical journal · May 2023
ReviewConvalescent Plasma Therapy in Late-State, Severe COVID-19 Infection.
Current evidence favors plasma to be effective against coronavirus disease 2019 (COVID-19) in critically ill patients in the early stages of infection. We investigated the safety and efficacy of convalescent plasma in specifically late-stage (designated as after 2 weeks of hospital admission) severe COVID-19 infection. We also conducted a literature review on the late-stage use of plasma in COVID-19. ⋯ This case series provides evidence that convalescent plasma may be safe and effective in late-stage, severe COVID-19 infection. Results showed clinical improvement posttransfusion as well as decreased all-cause mortality in comparison to pretransfusion predicted mortality. Randomized controlled trials are needed to conclusively determine benefits, dosage, and timing of treatment.
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Southern medical journal · May 2023
ReviewDirect Use of Clinical Tolerance Limits for Assessing the Degree of Agreement between Two Methods of Measuring Blood Pressure.
A large number of new methods of measuring blood pressure (BP) have recently emerged with advances in technology. Different methods of measuring BP generally provide varying readings compared with one another. Clinicians must decide how to respond to these variations and how to assess the degree of agreement. ⋯ This method requires a comparison of Bland-Altman limits with the prespecified clinical tolerance limits. This review describes an alternative simple and robust method that directly uses clinical tolerance limits for assessing agreement without calculating Bland-Altman limits. The many advantages of this method are illustrated with the help of real-life examples of BP measurements.
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Southern medical journal · May 2023
Impact of Preoperative Echocardiograms on In-Hospital Outcomes of Patients Undergoing Surgical Hip Fracture Repair and Their Clinical Appropriateness.
Preoperative transthoracic echocardiograms (TTE) before hip fracture repairs are controversial. This study aimed to quantify the frequency of ordering TTE, the appropriateness of testing based on current guidelines, and the impact of TTE on in-hospital morbidity and mortality outcomes. ⋯ Patients subjected to TTE before hip fracture surgery had a longer LOS and time to surgery, with higher mortality and intensive care unit up triage rates. TTE evaluations were typically conducted for inappropriate indications, which rarely made meaningful changes to patient management.
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Southern medical journal · May 2023
Medical Students' Perspectives on Opportunities to Engage in the Clinical Care of COVID-19 Patients during the Pandemic.
Recent disease modeling suggests that pandemics are likely to increase in frequency and severity. As such, medical educators must learn from their experiences with coronavirus disease 2019 (COVID-19) to develop systematic strategies for ensuring that medical students receive hands-on training in the management of emerging diseases. Here, we outline the process by which the Florida International University Herbert Wertheim College of Medicine developed and updated guidelines for student participation in the care of patients with COVID-19 and report on students' experiences. ⋯ Many graduating students felt unprepared to care for patients with COVID-19 during residency and many wished they had had more opportunities to care for patients with COVID-19 during medical school. Curricular policies must evolve to allow students to gain competency in the care of patients with COVID-19 so that they are prepared for day one of residency.
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Southern medical journal · May 2023
Identifying Gender-Related Differences in Graduate Medical Education with the Use of a Web-Based Professionalism Monitoring Tool.
Medical education is required to ensure a healthy training and learning environment for resident physicians. Trainees are expected to demonstrate professionalism with patients, faculty, and staff. West Virginia University Graduate Medical Education (GME) initiated a Web-based professionalism and mistreatment form ("button") on our Web site for reporting professionalism breaches, mistreatment, and exemplary behavior events. The purpose of this study was to identify characteristics in resident trainees who had a "button push" activation about their behavior to better understand ways to improve professionalism in GME. ⋯ Implementation of a professionalism-monitoring tool, such as our Web-based button push, identified gender differences in the reporting of professionalism breaches, because twice as many men as women were identified as the instigator of a professionalism breech. The tool also facilitated timely interventions and exemplary behavior recognition.